• Two patients had innominate artery disruption due to blunt rauma. Compression forces between the sternum and vertebral column and rotational forces were the mechanisms of injury. Mediastinal widening led to the diagnosis in one patient who underwent successful repair with preservation of cerebral flow by an aortic to subclavian bypass graft prior to oversewing the innominate artery. A normal mediastinal shadow led to a delay in diagnosis in the second patient who underwent surgery after the appearance of focal neurologic signs. The use of a temporary indwelling aortic-carotid shunt during repair did not prevent residual hemiparesis.